Provider Demographics
NPI:1932793627
Name:BIRTHSTONE TRAUMA HEALING, LLC
Entity type:Organization
Organization Name:BIRTHSTONE TRAUMA HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SOSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:215-258-8080
Mailing Address - Street 1:1943 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-2411
Mailing Address - Country:US
Mailing Address - Phone:434-509-3397
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT ST STE 603
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3516
Practice Address - Country:US
Practice Address - Phone:215-258-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1689227738OtherNPI-1
14504769OtherCAQH